Virchow's Views on Tubercle.—Virchow, in late papers on this subject,
advances the opinion that tubercle is the result of a metamorphosis of
organized elements. The following is the summary of his views.
111. Tuberculiz ition, the indubitably local process by which the body
described by the name tubercle is formed, is not a peculiar specifice exu-
dation, but a peculiar transformation of tissue elements, such as in 1847
I described in regard of cancer under the name of tuberculous metamor-
phosis.
11 2. The tuberculous metamorphosis is therefore co-ordinate with the
fatty and the waxy metamorphosis, calcification, and atheromatous de-
generation, but in no way co-ordinate with inflammation or serous effu-
sion, and even less so with suppuration or with cancerous formation.
“ 3. The tuberculous metamorphosis sometimes affects newly-formed
pathological tissues, sometimes the primitive, the so-called physiological
tissues, and finally, sometimes it affects both old and now simultaneous-
ly, and this last is its ordinary and peculiar characteristic. The tuber-
culous metamorphosis attacks cellular and transitory as well as fibrous
and permanent elements.
“4. The tuberculous metamorphosis consists in a cessation of the
nutritive and formative processes, in a mortification, death of the ele-
ments of the tissue, with subsequent peripheric absorption of the fluid
constituents, and drying-up of the parts lying beyond the sphere of nutri-
tion ; the death itself of the elements of the tissue is caused by the ac-
cumulation of cell-elements, and is immediately determined by compres-
sion of the vessels of the part.
‘£ 5. These cells may arise from an absolutely new formation, or from
an increased formation of the normal elements (epithelia, enchymkomer,
&c.,) or, finally, from an endogenous formation (ans. eincr endogenen
Bildung.)
“ 6. All these processes presuppose definite disturbances of the local
nutrition, especially an altered exudation, and point back, accordingly,
cither to inflammation itself or to an analogous affection, no matter
whether they owe their origin to an irritation produced by local mischief,
or to an excitation consecutive to constitutional causes, primary changes
of the blood, &c.
11 7. There is therefore an inflammatory, cancerous, typhous, glander-
ous, sarcomatous, &c. tuberculization, which are altogether the same in
reference to the essence of the local process, so far as this depends on
tissue metamorphosis, but which arc more or less different in reference
to the essence of the whole process, as well so far as the latter is local
(disturbance of nutrition, exudation, &c.,) as also when it is due to gene-
ral constitutional causes.
“ 8. Tuberculosis is the whole process of the affection, comprising the
conditions of the local disturbances of the process of nutrition with the
changes appertaining to it in the exudation, both in regard of the cell-
formation and transformation, and finding in tuberculization its constant
regular expression. Every tuberculization (tuberculous metamorphosis)
does not have its origin in tuberculosis; tuberculosis can be present, as far
as its early stages (exudation, cell-formation) are concerned, and yet there
may be no tubercle. We shall therefore call that diseased process tubercu-
losis, which in its ordinary course always leads to tuberculization ; while
we shall ascribe cancer and sarcoma, which accidentally tubercularize, to
an altogether different process, and shall never give the name of tubercle
to a thickened abscess, pus become cheesy, or pus concret.
“ 9. Scrofulosis is the constitutional affection which, after glanders
and typhus, the most frequently produces tuberculosis—i. e., the local
disease with the regular termination in tuberculization. But all its pro-
ducts are not tuberculous; tuberculosis is rather co-ordinate with a suc-
cession of other local processes.
“10. As tubercle is everywhere formed by the accumulation in the
tissues of cells of the most varied kinds, these cells in the majority of
cases breaking up, it has no peculiar characteristic elements. The shrivel-
led nuclei arising from the remains of the cells exhibit the greatest degree
of constancy in their outward characters, and therefore we can retain for
them the name of tubercle-corpuscles.”—Brit. and For. Med. Rev.